How Is Hepatitis C Diagnosed?

Many people living with this disease don't have any symptoms at all. That's why knowing how to detect it early is crucial.

by Amy Marturana Winderl Health Writer

Silent, sneaky, invisible. These are all words used to describe hepatitis C—a chronic liver condition that can affect your body without showing any real symptoms for a long time. Of the more than 3 million Americans living with chronic hepatitis C, most don’t know they are infected, according to the U.S. Department of Health and Human Services. In fact, many people with hep C can go 20 or 30 years before realizing something is wrong, says Robert John Fontana, M.D., professor of medicine at the University of Michigan in Ann Arbor and medical director of liver transplantation at Michigan Medicine. “You can harbor the virus silently for decades,” he says. By that point, the hepatitis C virus (also known as HCV) has had enough time to slowly damage your liver and start to mess with important bodily functions in a major way.

All of this sparks the burning question: If symptoms are so elusive, how can hepatitis C ever be diagnosed? Here’s what you need to know to protect your liver—and more.

Early Diagnosis Prevents Disease Spread

The longer you wait before treatment, the greater the odds of permanent liver damage. If liver damage goes unchecked for too long (the exact amount of time varies from person to person, but it could take 20 years or more), it can lead to serious problems throughout the body, including bleeding in the digestive tract, trouble absorbing nutrients from food, memory problems, and even type 2 diabetes.

Also, the longer you live with hepatitis C before being diagnosed, the greater the chance you may unknowingly spread it to other people. HCV is transmitted through the blood, so while it’s not as easy to catch as, say, the flu, it can be spread from person to person in a household.

“If you share toothbrushes or razors, for example, you could inadvertently transfer it and not know,” Dr. Fontana says. “Sexual transmission is also possible, so you would want to use some form of barrier contraception—like condoms (male and female), diaphragms, cervical caps, and contraceptive sponges—or wait until you’ve been treated.”

Potential Symptoms You Should Know

Some people experience symptoms early on, but because many of those indicators are pretty general, they are not easily used to diagnose hepatitis C. For example, you may feel fatigued and just generally lousy for a little while soon after being infected, says Geoffrey D. Block, M.D., medical director of liver transplant at the University of Arizona College of Medicine in Tucson. But those symptoms could be a sign of so many other things—even just the result of a poor night’s sleep.

There are a few red flags to look out for, though. And if you have several of these things going on at once—vague as they may be—it’s a good idea to see your doc and talk about hep C. These symptoms may include:

  • Dark yellow urine

  • Gray-colored stool

  • Fever

  • Joint pain

  • Loss of appetite

  • Nausea

  • Vomiting

  • Pain in the abdomen

  • Yellowish skin and eyes (jaundice)

There are two important caveats here: First, if these symptoms show up at all, it would typically happen two to 12 weeks after becoming infected with hepatitis C (what’s known as the acute period). So if you engage in certain activities, including unprotected sex or sharing needles, and you start experiencing these things in the weeks following, get yourself to a doctor. Second, more than half of people who become infected with hepatitis C virus will go beyond the acute period and develop a chronic infection. In this case, it’s entirely possible you won’t show any symptoms for several decades.

The Latest Screening Recommendations

Because the vast majority of people with hepatitis C do not have symptoms, diagnosing the disease requires screening—basically, a proactive testing method for a disease before someone is showing indications of illness. The latest recommendation from the Centers for Disease Control and Prevention (CDC), updated in 2020, is that all adults over the age of 18 should be screened at least once in their lifetime, Dr. Fontana says. If you have ongoing risk factors—you’re currently using injection drugs or are on dialysis, for example—then routine screening once per year is recommended. Pregnant women should also be screened for hepatitis C during each pregnancy.

If you don’t know if you’ve ever been screened or if you have any of the known risk factors of hepatitis C, ask your primary care doctor about being tested. Some of the big risk factors include:

  • Sharing needles or other equipment to prepare or inject drugs

  • Getting tattooed or pierced with an unsterile needle

  • Living with HIV

  • Having a blood transfusion or organ transplant before 1992, when pre-screening blood for infections like HCV was poor

The test for hepatitis C should be covered by insurance, and should be given to anyone who asks, even if you don’t feel comfortable disclosing exactly why you want it.

How Hepatitis C Diagnosing Works

The screening process to diagnose hep C is done with a simple blood test. It’s not usually included in the panel of tests you get at your yearly physical, but the lab can use the same tube of blood to test for hepatitis C if your doctor orders it, Dr. Fontana says.

Several tests are available, but in general, they look for antibodies in your blood. These antibodies are proteins that the immune system creates to fight off specific invaders, like the hepatitis C virus. So if you’ve been exposed to hepatitis C at some point in your life, the antibodies will reveal this fact, says Dr. Block.

If your blood test reveals that you do in fact have hepatitis C antibodies, another blood test will be done to find out two things:

  1. How much of the virus is currently in your bloodstream

  2. Which genotype it is

There are seven different variations of hepatitis C, called genotypes. Some hepatitis C treatments are only effective against one specific genotype, while others can treat all of them, Dr. Block says. Knowing exactly how much virus is present and what its anatomy is will help your doctor figure out the absolute best way to treat it.

Just because you have antibodies, though, doesn’t mean your doc will diagnose you with hepatitis C. (Confusing, we know.) If the second blood test finds no active virus, that means your body cleared the infection on its own, Dr. Fontana explains. But it’s still crucial to stay on top of screening (and avoid high-risk activities), because even if you’ve had HCV before and have antibodies, you can still get it again.

And if the second test does confirm a hepatitis C diagnosis, don’t panic. Very effective treatments are available, and after about eight to 12 weeks, more than 90 percent of people are cured. Once you have a diagnosis, you’re already halfway there.

Amy Marturana Winderl
Meet Our Writer
Amy Marturana Winderl

Amy is a freelance journalist and certified personal trainer. She covers a wide range of health topics, including fitness, health conditions, mental health, sexual and reproductive health, nutrition, and more. Her work has appeared on SELF, Bicycling, Health, and other publications. When she's not busy writing or editing, you can find her hiking, cooking, running, or lounging on the couch watching the latest true crime show on Netflix.